| Department File Number : | M201575684 |
| Claim Number : | HMA26466 |
| Date Submitted : | 9/2/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| COLUMBIA CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 47-0490411 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Shauna | Jumper | |||
| Street Address | |||||
| 333 S Wabash Ave | |||||
| City | State | Zip | |||
| Chicago | IL | 60604 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (312) 822 - 5419 | Shauna.Jumper@cna.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mitchel | A | Senft | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 6633 Forest Hill Blvd | ||||
| City | State | Zip Code | County | ||
| Greenacres | FL | 33413 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| SLD 4022836458 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN9386 | Dental Public Health | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Dental office | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/7/2013 | 4/22/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Needed to have upper anterior teeth extracted due to a bony issue, and had to have bone grafting done. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient was given specific instructions post operation but unfortunately, the flap opened up and the graft failed. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Insured failed attempted to bone graft on the upper anterior. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/19/2014 | 2014 CA 011053 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 8/17/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 8/12/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $20,384 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $8,084 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Insured discussed case with defense counsel and insurance personnel | |||||||||||||||||||||
| Updates | |
| No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MITCHEL A SENFT, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MITCHEL A SENFT, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).